DR BURNS: Mr C is a 58-year-old man diagnosed
as having chronic Lyme disease. He lives in a suburb of Boston and works as
a consultant. He has managed care insurance.
Mr C had an episode of Bell's palsy on the left side of his face in
August 1992 and reported that he spent a lot of time on Martha's Vineyard,
an endemic area for Lyme disease. Subsequently, he noticed that he became
less competent mentally. He could not do simple math and he became depressed.
In 1994, he was diagnosed as having Lyme disease. At that time, he complained
of neck pain radiating to his left shoulder and hand, with numbness and tingling
in his hand; back pain that radiated down his left leg; bilateral joint aches
in both elbows and, to a lesser extent, his shoulders; bilateral tinnitus;
periodic blurred vision (worse in the right eye than the left); difficulty
concentrating and word finding; and periodic sweats. Results of his physical
examination were normal with the exception of having difficulty spelling "world"
backward and subtracting 7 serially. In October 1994, his Lyme (IgM/IgG) antibody
titer was positive at 1:4. He was treated with tetracycline, 500 mg 3 times
daily for 1 year.
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